Should Doctors Undergo Opioid Prescribing Risk Training?

Earlier this week, an advisory panel recommended that the Food and Drug Administration require doctors who prescribe painkillers s to undergo training aimed at reducing misuse and abuse of the medications. The New York Times notes: It is the second time since 2010 that an F.D.A. panel has recommended expanding safety measures for painkillers. But the trainingContinue reading “Should Doctors Undergo Opioid Prescribing Risk Training?”

More evidence-concordant FDA guidelines increase access to mifepristone

As covered in the New York Times, this week the Food and Drug Administration relaxed the guidelines for taking mifepristone (Mifiprex, formerly RU-486), a pill that induces abortion, reviving one of the most contentious issues of the abortion debate. The change brings the directions for taking the drug, mifepristone, in line with what has become standard medical practice in most states: reducing the dosageContinue reading “More evidence-concordant FDA guidelines increase access to mifepristone”

Do we need Robin Hood to improve our access to medical research?

A graduate student from Kazakhstan named Alexandra Elbakyan  went into hiding after illegally providing free online access to just about every scientific paper ever published, on topics ranging from acoustics to zymology. Paraphrasing part of the United Nations Charter, Ms. Elbakyan said, “Everyone has the right to freely share in scientific advancement and its benefits.” Her file-sharing website is here: Sci-Hub. A New YorkContinue reading “Do we need Robin Hood to improve our access to medical research?”

The difference between the parties’ health care proposals boils down to how they distribute risk

In a Health Affairs blog post today, two Urban Institute scholars–economist Linda Blumberg and policy fellow John Holahan–state that the fundamental difference between the two parties’ health care proposals is how they propose to share health care expenditures between those currently healthy and those with costly health care needs. The health policies of the two political parties and theirContinue reading “The difference between the parties’ health care proposals boils down to how they distribute risk”

Emergency Department Return Visits as a Quality Metric

A recent JAMA publication lead-authored by Dr. Amber Sabbatini examined the scientific soundness of emergency department (ED) return visits as a measure of the ED’s quality of care. Emergency department return visits have been considered for wider adoption as a quality metric, especially for those patients who are hospitalized during the return ED visit. The “quality”Continue reading “Emergency Department Return Visits as a Quality Metric”

Coffee: to drink or not to drink

According to the U.S. Food and Drug Administration, 90% of people worldwide, and 80% in the US, consume caffeine in some form every day. The average adult has an intake of about 200 milligrams, or roughly one cup of coffee per day. As one of those few non-coffee-drinking adults–probably rarer still among emergency medicine providers–I was intrigued by  today’s New YorkContinue reading “Coffee: to drink or not to drink”

Readmissions revisited

I am reposting  a post by Garret Johnson and Zoe Lyon, both research assistants for Dr. Ashish Jha at the Harvard T.H. Chan School of Public Health (who also has a great post on risk-adjustment for readmissions.  The post eloquently explores an issue I’ve visited in a recent post: the importance of understanding the diverseContinue reading “Readmissions revisited”

Guns, Drugs and Cars

This week’s JAMA released a comparison of major causes of injury death and how they contribute to the gap in life expectancy between the US and other high-income countries. Here are their findings: Men in the comparison countries had a life expectancy advantage of 2.2 years over US men (78.6 years vs 76.4 years), asContinue reading “Guns, Drugs and Cars”

How Performance Metrics Fail Healthcare

A recent New York Times article calls attention to the unintended consequences of healthcare performance metrics.  (Disclaimer: I am am favorably disposed to cite any piece that quotes Avedis Donabedian, one of the fore-parents of health quality research methods.)  With widespread use of the electronic health record, gathering data for performance metrics increasingly overshadows clinical care. AContinue reading “How Performance Metrics Fail Healthcare”

Is it ethical to incentivize “wellness”?

In an essay on medical ethics, Harald Schmidt explores the question: is it right for employers and health plans to offer incentives to employees/members to pursue health care that is not informed by evidence?  He uses as his example several large insurers paying young (younger than 50, even younger than 40 years), low-risk women to obtain mammograms.  The evidenceContinue reading “Is it ethical to incentivize “wellness”?”